MMI Policy Flashcards
Views on child immunization requirements
- CDC recommends certain vaccines for children and many times schools require these vaccines for kids to begin school, however certain exemptions are in place
- Recently read an article based of a CDC study conducted earlier last year which found that over 200,000 kindergarten students in the country lacked full vaccine protections –> certainly a higher than expected number, especially since vaccines were once celebrated as public health success stories
- Vaccines not only protect the child receiving them from getting a potentially dangerous disease, it is also benefiting the health of the public at large since most of these diseases are contagious and lead to outbreaks such as the Measles outbreak which occurred in Ohio during the end of 2022
- Now with this being said, I also think it is important to validate the many questions and the fear some parents have when vaccinating their children –> vaccines can very rarely cause severe allergic RXNs and some unwanted side effects, and I can understand why this worries some parent
- I think it is important to provide parents and the community at large with as much information as possible regarding the benefits of vaccinating their children as well as be patient in the clinic when they have questions
- Also essential to be respectful of the exemptions in place whether they are religious or cultural in nature
- I think the key to getting more vaccinated children is to provide accessible knowledge on the topic (both on and off the internet and in various languages) in order for parents to make the best informed decision for their kids. Ultimately, after this, we must respect the parent’s decisions
You are on your stationary bike exercising and filling through the TV channels. You come across a news story that discusses the following: A recent report by the health authorities has revealed that there are more deaths due to preventable and common diseases in rural areas as compared to urban settings. In your opinion, what could be causing the observed difference, and how can we address this problem?
- Healthcare disparities between urban and rural cause of concern for years
- Could be caused by inadequate access to nutritious food or lack of healthcare availability
- Primarily I think these observed differences are happening because rural communities tend to not have many if any primary care/preventative services –> small health problems are not addressed early and thus snowball into a more complex condition with subsequent worse health outcome
- Living in rural Barrio Nuevo Naranjito PR, I was lucky enough to have a pediatrician who I could see once a year, but my mom would wake me up at 3 AM to drive over to the office and secure a spot near the front of the line –> wait to see the doctor lasted about 4 hrs
- To address this problem, I think it is important for future doctors to first be aware of how serious it is and I think this can be accomplished by exposing medical students to rural communities in order to experience first hand the detrimental effects that this lack of healthcare has on communities
- Also, another aspect which is already being worked on by various states and medical schools is providing incentives to medical students who wish to work in rural communities after graduation
- I think if these patients have adequate access to preventative services, the number of differences in health outcomes between rural and urban communities will decrease
What are your views about the legalization of marijuana for recreational use?
- Marijuana does cause short term effects such as poisoning and potential overuse as well as long term effects such as dependency –> HOWEVER research has shown that similar to other substances, cannabis does not affect everyone the same way
- THUS, I think we can treat it the same way we would alcohol; doing our very best to limit its access to adults who can use it responsibly and inform the general public on 1) what marijuana is, 2) how it could potentially affect them, and 3) how to use it safely
- Legalization of recreational marijuana can have a positive impact on the crime rate and the economic wellbeing of the state –> for example here in MA we tax for these sales which is benefiting the economy of the state and by making these sales legal, we are taking business away from illegal drug dealers which will likely reduce the crime rates in relation to this specific substance
Views on vaccination
- Many benefits to vaccinations including long term benefit to the individual by protecting them from acquiring a potentially dangerous disease in the future. MOREOVER, vaccinations protect the health of the public at large since many of these diseases cause outbreaks, such as the measles outbreak that happened in Ohio towards the end of 2022.
- By reducing these outbreaks we are also reducing the burden on the healthcare system, (as the logic would be that vaccinated individuals are less likely to become sick from that disease to which they were vaccinated against).
- HOWEVER, it is important to recognize that many individuals are apprehensive to vaccines due to all the misinformation out there. It is also important to validate the fact that vaccines can cause minor side effects and rare allergic reactions, but this is the case for any medication or even foods we consume
- I think it is imp to inform our patients on all the benefits of vaccination as well as the minor risks associated with them - ultimately we need to respect their autonomy as well as any religious and cultural beliefs they have
What is your opinion on the ACA?
Changed the way that individuals are able to acquire health ins
Pros: Individuals younger than 26 can remain in their parent’s ins policy, subsidizes can allow for more affordable premiums based on a pt’s income level, no exclusion based on pre-existing conditions and also ins. companies can no longer place a limit on how much to spend on a pt. Another benefit of the ACA is having preventative services available without cost - although I started working at Emerson after the ACA was implemented, many pts have expressed during check in how “helpful” or what a “blessing” it is to get “at least a checkup” once a year
Cons: People who already had health insurance may be faced with a higher premium, since now the ins companies are faced with having to cover more healthcare services and a greater number of individuals. Also, even though the ACA provides subsidizes to pts below a certain income level, those with a several chronic conditions or who take a lot of prescription medications may still not be able to afford all their healthcare despite paying their monthly premium - I once met a pt at Emerson who admitted she had to pick which of her conditions caused the worst sx and purchase those medications, leaving her unprotected against her other health conditions such as high blood pressure and asthma - the cost of preventative inhalers is too much even when using apps such as good rx and often times, pts such as this one admit to having “the red inhaler” aka albuterol, the rescue inhaler but they are not taking their preventative medications because they can’t afford them.
I think the ACA is certainly an improvement but there is still much work to be done, such as addressing those with a high # of chronic health conditions and who take a large # of medications
What are your thoughts on universal healthcare?
- Implemented in many countries —-> I think a universal healthcare system would certainly help us serve those who need it most, such as individuals who don’t get the care they need because of financial barriers.
- This type of system I think also decreases stress and anxiety on the pt’s side because they know they can get the care they need without having to worry about cost
- Also, universal healthcare equalizes the care provided to all pts
——> All these factors combined are likely to increase life expectancy <—— - HOWEVER, when implementing such a system, it is likely that since pts can receive care when they need it, without cost they are likely to go to the doctor for reasons that may not quite require an office visit
- This increases the number of patients a doctor has to serve and may very well lead to a decrease in the quality of care over time
- MOREOVER, it could increase the already high level of physician burnout that is present
- Another important aspect to consider about universal healthcare is the fact that in order for the gov to afford it, it will likely need to INC taxation on citizens and depending on the type of system that is exactly in place, healthcare providers and pts may feel they have less autonomy in their choice of tx (e.g. socialized medicine in UK aka National health service NHS)
What is your opinion on medicinal marijuana?
- Has become legal in different states, including MA and each state has their own guidelines on what medical conditions can be treated with medicinal cannabis
- Many pts who use CBD-dominant strains of marijuana also report feeling little to no changes in consciousness given that the THC is usually the component responsible for this feeling
- Imp to note that this is not an FDA approved treatment and under federal law marijuana is still classified as a sched. 1 substance w/high potential for abuse
- Nonetheless, studies have shown that medicinal marijuana helps pts w/many ailments; one of the most common ones being chronic pain and that medicinal marijuana use is associated w/decreased use of opiates in pts w/chronic pain
- Unlike opiates, which have a high risk of death due to overdose, marijuana users that overdose may experience serious, potentially dangerous side effects but the risk of death is very low. In fact, the Drug Enforcement Administration reported in 2020 that no deaths from marijuana overdose had been reported
- Given this, I think it is important to remember the fact that marijuana is still a scheduled 1 substance, but that when compared to opiates, it is likely a much safer option for certain conditions when conservative tx have failed to help the pt. In states such as this one where medical marijuana is legal, my opinion is that practitioners should be informed on the risks and benefits of this treatment and be open to having discussions with their patients regarding this potential route
What is your opinion on surrogacy?
I think depending on the situation, gestational surrogacy can be a good option for couples who are looking become parents. Surrogacy in general is a very complicated process. Despite all the legal work that goes into the planning, emotional responses from both sides complicate the journey; sometimes positively where a bonding friendship can take place between the couple and the surrogate and her family while other times it can neg complicate the journey, if a party later decides not to uphold their end of the bargain (for example if a contract stated the surrogate could see the child once a month but later the parents decide this won’t be doable). Moreover, traditional surrogacy, where the surrogate is actually biologically related to the child, further complicates the process. All of these aspects should be carefully discussed with a couple before they decide to commit their time and finances to a surrogacy process as often times we only think about the very obvious positive outcome which is the birth of a child.
Gestational vs Traditional Surrogacy
Gestational: Surrogate has no genetic relationship to the baby she is carrying
Traditional: Rare but cheaper form where the intended father’s sperm is implanted in the surrogate
What is your opinion on stem cell research?
- Stem cell research is very controversial and ultimately individuals on both sides of the debate are interested in protecting what they perceive to be human life
- On one end, we have individuals who believe using blastula for research purposes (as is the case for stem cell research) is akin to ending a potential unborn life
- Although the blastula has not yet developed to become a person, many who are against SCR believe an embryo, who has the capacity to become a person, should be respected as such
- On the other hand, the field of SCR has been shown to be very promising for various diseases including cancer, AD, and PD and thus individuals who are for it believe that actually conducting it will lead to potentially improving and saving the lives of many
- Individuals who are pro SCR have the belief that embryos are not to be considered a person since there is no capacity to develop any organs or have any of the physical or emotional properties that we usually associate with a person
- I certainly understand both sides and I think ultimately it comes down to what individuals consider to be a “person” and this perception varies depending on cultural and religious belief
- Ultimately if I had to give my own opinion, I support SCR if it is legal to conduct and a state permits the use of stem cells to advance research; another very important aspect to consider is who this research will benefit in the long wrong, whether the findings and potential lifesaving tx will be available to a wide range of pts or only some and whether ultimately the tx will benefit my pt and not harm them (e.g. it may be life saving for my pt but if their religious beliefs are against SCR, could it potentially harm them emotionally and mentally?)
What is your opinion on animals as research subjects?
- Animals are good research subjects because they are susceptible to similar health problems as humans and are biologically similar to us
- However, my opinion is that alternatives should be seeked (e.g. tissue, computer models) if at all possible before using animals as research subject
- In the event that it is absolutely necessary to use them –> there are federal regulations in place that need to be followed in order to ensure that humane and responsible research is being conducted
Discuss the current problems the country is facing regarding mental health
- Mental health problems are becoming increasingly common for pts of all ages, especially since the start of the COVID-19 pandemic
- Recent survey from CDC reported that 2 out of every 5 teenagers felt persistently sad
- Medical community is trying to be more open to discussing mental health but due to it being stigmatized so much in certain cultures, even to this day, certain pts are reluctant to talk about it and be receptive to education - our ofc screens for anxiety and depression every yr during PE and usually it is male pts who feel the need to get defensive during these questions –> I think this is one of the key points is helping pts realize that mental health is still health and that as providers we are invested in their mental health as much as their physical health
- When pts are open to these topics, they are much more responsive to information and advice to seek mental health services —> this brings up another problem which is the fact that mental health services are struggling, a lot of the pts we refer are placed on waitlists
- As for children and teenagers, bringing education about what mental health is to schools and encouraging them to speak if they ever start to feel “different” emotions more often is essential
